ASHP Pharmacy Technician Initiative and Pharmacy Practice Model Initiative: This case study is a resource that supports the goals of PPMI and the PTI and the critical roles pharmacy technicians have in patient care. Important characteristics of current and evolving advanced technician practice models include training through an ASHP accredited training program, PTCB certification, and licensure with a Board of Pharmacy.
Primary Intended Outcome(s)
- To ensure that medication lists are updated for every patient admitted through the emergency department.
- To improve accuracy of prior to admission medication histories.
- To optimize patient outcomes through interdisciplinary medication management in the emergency department.
Associated with the following PPMI Recommendation or ASHP Strategic Plan Goals
- Initiation of medication reconciliation including obtaining and documenting patients’ medication information for pharmacists’ review.
- Reviewing patient charts to identify medication
Site Description
Lee Memorial Health System (LMHS) is a 1,423 bed community non‐profit health system with five campus locations. One hospital is a Level II Trauma Center. LMHS also has ambulatory infusion center and a regional cancer center. LMHS Pharmacy Services are provided 24 hours a day to both inpatient and outpatients. The system pharmacy department includes approximately 230 FTEs including 140 pharmacists (and residents) and 110 pharmacy technicians.
Advanced Role Description
Seventy percent (70%) of inpatients are admitted through the Emergency Department (ED) at LMHS. We wanted to reduce the number of prior to admission (PTA) medication history errors. We piloted a program utilizing pharmacy technicians in the ED to complete medication histories and experienced a reduction of errors from 7.7% to 3.1%.
Duties include
Pharmaceutical Care
- Obtain patient allergies and prior to admission medication histories from relevant sources includes but not limit to patient interview, phone call to outpatient pharmacy /nursing home /provider's office. Such information should be processed in the Electronic Health Record (EHR).
- Clarify patient allergies and prior to admission medication histories from relevant sources includes but not limit to patient interview, phone call to outpatient pharmacy /nursing home /provider's office. Such information should be processed in the EHR.
- Directly communicate to the pharmacist about the patient with complex /high‐risk medications inclusive of prior to admission medication list as define by policy.
- Document any appropriate medication history related intervention in EHR.
- Collects patient's insurance information and enter in EHR.
- Inform each patient about ambulatory pharmacy on campus as available resource to fill prescriptions upon discharge.
- Facili ate or direct appropriate medication related questionnaires to the pharmacist.
- Interacts effectively with other emergency department health care team on a regular basis.
- Within scope of practice assist pharmacist to facilitate pharmaceutical care to the patient.
- Prevent, detect, monitor, document and report medication errors
- Facilitate discharge/transfer for the ED patients
Drug Distribution Support
- Expedite medication administration by all appropriate mechanisms (coordination with central pharmacy)
- Resolve drug distribution related issues.
- Resolve automated dispensing system‐related issue.
- May require consulting Pharmacy Automation Technicians (PAT)
Teaching/Communication
- Provide training of new hires or students
- Participate actively in the ED staff meetings/ huddles
Regulatory and/or Legal Requirements
- Pharmacy technicians performing this function are all certified by the Pharmacy Technician Certification Board (PTCB), and are trained and determined to be competent to perform these functions by the LMHS pharmacy department.
Revenue & Expense Parameters (abbreviated financials)
- Expenses for personnel allocation to these functions have come from reallocation of existing personnel to perform these duties; in addition there have been incremental additions of staff from transfer of positions from the Emergency Department to Pharmacy.
Training and/or Education Requirements
- Additional training and demonstration of competency required; training involves customer service skills, communication skills and drug name/prescription competency (including look alike sound alike drugs).
Short‐term results
- Currently have technician in ED 8 hours a day, 5 days a week.
- Reduced medication history errors from 7.7% to 3.1%
Long‐term goals
- Expand technician hours to 16 hours a day, 7 days a week
- Capture a medication history on every patient
- Dedicate pharmacy personnel on the patient care unit to obtain medication histories (to capture the direct admit patients that do not come through the ED)
- Reduce the errors of proper medication history documentation even further.
Lessons Learned
ED pharmacy technicians play a valuable role in obtaining patient's medication histories. Expansion of this service to 24 hours, 7 days a week will help to capture every single patient that comes through the ED. By having a correct medication history, the patient will receive better care through the transition of outpatient to inpatient settings.
References
Michels RD, Meisel SB. Program using pharmacy technicians to obtain medication histories. Am J Health‐ Syst Pharm. 2003; 60:1982‐6.
Knight H, Edgerton L, Foster R, Pharmacy technicians obtaining medication histories within the emergency department Am J Health Syst Pharm